Reflux Laryngitis

  • Medical Author:
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

  • Medical Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Reflux laryngitis facts

  • Reflux laryngitis is inflammation of the voice box (larynx) caused by stomach acid backing up into the esophagus.
  • Reflux laryngitis can cause chronic hoarseness and be associated with other symptoms of inflammation of the esophagus, such as heartburn.
  • Medical treatments for reflux esophagitis include medications (acid blockers or proton pump inhibitors), or surgery.
  • Behavioral modifications such as weight loss, quitting smoking, and proper food choices can decrease symptoms of reflux laryngitis.

Why does reflux laryngitis occur?

Reflux is caused by weakness in the muscle at the junction of the esophagus with the stomach. Normally, this muscular valve, or sphincter, functions to keep food and stomach acid from moving upward from the stomach to the esophagus and larynx. This valve opens to allow food into the stomach and closes to keep the stomach's contents from coming back up. The backward movement of stomach contents (gastric contents) up into the esophagus is called gastroesophageal reflux.

Additionally, any increase in abdominal pressure (such as obesity or tight clothing), which can push acid back from the stomach up the esophagus, or a  patient with a hiatal hernia, will have an increased risk for reflux. When it causes symptoms, it is referred to as gastroesophageal reflux disease (or GERD). When the acid backs up into the voice box (larynx), the condition is referred to as reflux laryngitis.

Stomach acid can cause irritation of the lining of the esophagus, larynx, and throat. This can lead to:

  • erosion of the lining of the esophagus (erosive esophagitis),
  • narrowing of the esophagus (stricture),
  • chronic hoarseness,
  • chronic throat clearing,
  • difficulty swallowing,
  • foreign body sensation in the throat,
  • asthma or cough,
  • spasms of the vocal cords,
  • sinusitis, and
  • growths on the vocal cords (granulomas).

Rarely, reflux can lead to cancers of the esophagus or larynx.

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What are the typical symptoms of reflux laryngitis?

Heartburn is the most common symptom associated with reflux. The American College of Gastroenterology estimates that more than 60 million Americans experience heartburn at least once a month and some studies suggest that more than 15 million people experience heartburn symptoms each day. The incidence of GERD is on the rise, and the rise in obesity is believed to be a contributing factor. In addition to heartburn, reflux severe enough to cause laryngitis can cause chronic hoarseness, asthma, or a foreign body sensation in the throat (globus phenomenon).

How is reflux laryngitis evaluated?

In most patients, the presumptive diagnosis of reflux laryngitis is based on the typical history of heartburn and hoarseness. Testing usually is reserved for those patients who do not respond to conservative therapy (as explained below) or drug therapy. Diagnostic tests includes an:

What are home remedies, OTC medications, and lifestyle changes (diet) that can help reflux?

The treatment of reflux laryngitis is the treatment of gastroesophageal reflux.

  1. Antacids neutralize stomach acid and give immediate relief. Popular choices include sodium bicarbonate (Alka Seltzer), calcium carbonate (Tums, Rolaids, Alka-Mints), and aluminum and magnesium antacids (Maalox, Mylanta, Riopan, Gaviscon). IUse antacids 30 to 60 minutes after each meal and at bedtime because they are more effective at these times. Patients on a low sodium diet should avoid sodium bicarbonate. Calcium and aluminum can cause constipation, while magnesium antacids can cause diarrhea. Patents with kidney disease should avoid magnesium and aluminum antacids. Patients should check with their pharmacist or doctor for any interactions with other medications they are taking.
  2. Avoid large meals for dinner.
  3. Allow several hours after eating before lying down to allow the stomach to empty. Avoid eating after the evening meal and before bedtime.
  4. Avoid spicy or fried foods, peppermint, citrus, tomatoes, onions, and chocolate, especially if these foods increase symptoms,.
  5. The diet should be high-protein, high-carbohydrate, and low fat.
  6. It may be helpful to elevate the head of the bed with wooden blocks under the bedposts to allow gravity to keep the acid in the stomach. Pillows under the head are not helpful though wedges that elevate the head and upper chest are effective.
  7. Avoid alcohol, caffeinated beverages, and tobacco.
  8. Losing weight reduces reflux.
  9. Drugs such as nonsteroidal anti-inflammatory drugs (NSAIDS), theophylline (Theo-Dur, Respbid, Slo-Bid, Theo-24, Theolair, Uniphyl, Slo-Phyllin), anticholinergics, and calcium channel blockers should be avoided if feasible, but discuss discontinuing any medication with a doctor first.

What types of medications are used to treat reflux?

There are several different types of medications available over the counter (OTC) or by prescription. The acid-blocking drugs (famotidine [Pepcid], cimetidine [Tagamet], nizatidine [Axid], ranitidine [Zantac]) are known as H2-blockers. These are available without a prescription. However, their strength may be inadequate.

Other valuable medications include: metoclopramide (Reglan), which helps to empty the stomach; or the proton pump inhibitors, such as omeprazole (Prilosec) and lansoprazole (Prevacid).

If conservative therapy and medical therapy fail, surgery may be necessary. Traditionally, the fundoplication procedure, which serves to strengthen or recreate the muscular valve (lower esophageal sphincter), requires significant surgical work and hospital stay. Recently, surgery also has been able to perform endoscopic fundoplication, shortening both hospital stay and recovery. However, this is still investigational and not considered the standard of care.

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What are the difficulties in diagnosing reflux laryngitis?

In some patients it appears clear that the laryngeal symptoms - hoarseness, cough, sore throat - are due to reflux, for example, in patients with marked heartburn and regurgitation of acid.

In most patients with laryngeal symptoms - those with milder heartburn and no regurgitation who comprise the majority of patients in whom reflux laryngitis is considered - it is not as clear. Examination of the larynx may reveal redness and swelling, but these signs can be caused by many diseases of the larynx as well as reflux.

There are difficulties with using symptoms to diagnose reflux. For example, cough may occur when there is reflux into the esophagus. Refluxed liquid does not need to reach the larynx.

Finally, it is unclear whether or not refluxed liquid from the stomach that is not acid can cause reflux laryngitis, and there is no way of testing whether or not non-acid liquid is reaching the larynx. Many physicians use a trial of potent acid-suppression with PPIs to try to prove that acid reflux is the cause of the laryngeal symptoms. The problem with a trial of PPIs is that some symptoms such as cough and throat clearing can be caused by habit, and the PPIs may have a placebo effect. Thus, a response to PPIs may not be proof that reflux is the cause of symptoms.

Medically reviewed by Joseph Palermo, D.O,; American Osteopathic Board Certified Internal Medicine

REFERENCE:

MedscapeReference.com. Reflux Laryngitis

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Reviewed on 8/23/2016
References
Medically reviewed by Joseph Palermo, D.O,; American Osteopathic Board Certified Internal Medicine

REFERENCE:

MedscapeReference.com. Reflux Laryngitis

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